Old Mill Veterinary Hospital

(703) 779-2903

91 Lawson Rd SE
Leesburg, VA 20175

Monday-Friday: 7am-7pm
Saturday: 8am-3pm
Sunday: Closed


COVID-19 NEW PROTOCOL
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New Client Information Form

  • Client Information

    Note: if there is a field not applicable to you, please fill in with N/A.
  • Patient Information

  • I, the undersigned, authorize the veterinarian(s) and staff employed by Old Mill Veterinary Hospital to examine, prescribe for and treat accordingly up to and including medical surgical procedures for the patient/s specifically described and identified above.

    I assume responsibility for all charges incurred for services rendered to the patient/s.

    Also, I understand payment is due when services are rendered. Deposits may be required for some services.

    There are additional fees assessed for non-payment, returned checks and accounts sent to collection. I understand and agree to pay these fees.

  • This field is for validation purposes and should be left unchanged.
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